NPIMap

Organization Active NPI

Antioch Dentistry PA

  • General Practice Dentistry
  • Merriam, KS
National Provider Identifier
1720490261
Registry record updated May 11, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
Legal business name
ANTIOCH DENTISTRY PA
Practice address
5754 Antioch Rd
Merriam, KS 66202-2015
Phone
(913) 671-7066
Fax
(913) 671-7058
NPI assigned
Jun 2, 2014
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 11, 2022

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Taylor Sutherland, DDSNPI 1457700650
Title
Owner
Phone
(913) 671-7066

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice DentistryGroup: 193200000X MULTI-SPECIALTY GROUP 1223G0001X Primary

Addresses

Primary practice location

5754 Antioch Rd
Merriam, KS 66202-2015

Mailing address

PO Box 920050
Dallas, TX 75392-0050
Phone (714) 845-8890

Other names 1

  • Antioch Dentistry Doing business as

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
17D2336922Antioch Dentistry5754 Antioch Rd, Merriam, KS 66202Certificate of waiverJan 12, 2028

National Provider Directory

National Provider Directory

Locations

5750 Antioch Rd
Merriam, KS 66202

5754 Antioch Rd
Merriam, KS 66202
Phone (913) 671-7066

Practitioners & affiliated clinicians

Practitioners 12

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1401667200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1652227200000",
    "number": "1720490261",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 920050",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "753920050",
            "telephone_number": "714-845-8890",
            "fax_number": "949-474-1495"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5754 ANTIOCH RD",
            "city": "MERRIAM",
            "state": "KS",
            "postal_code": "662022015",
            "telephone_number": "913-671-7066",
            "fax_number": "913-671-7058"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ANTIOCH DENTISTRY PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-06-02",
        "last_updated": "2022-05-11",
        "certification_date": "2022-05-11",
        "status": "A",
        "authorized_official_last_name": "SUTHERLAND",
        "authorized_official_first_name": "TAYLOR",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "913-671-7066",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, General Practice",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Antioch Dentistry",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Antioch Dentistry",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Merriam, KS

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 11, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.